Matariya Qabristan in Karelibaug area of Vadodara, which has been designated for Covid-19 burials in the city. (Photo: Bhupendra Rana)
Matariya Qabristan, the designated Covid-19 Islamic cemetery in Vadodara, now has space for only 20 more burials. Until May 5, the land had seen 18 burials, 16 of which were confirmed cases from Vadodara city. Since then, the cemetery has seen at least eight more deceased being put to rest following the Covid-19 burial protocol.
Zakir Saiyed, who oversees burials at Matariya Qabrastan, said the burial ground has four 15-feet-deep graves ready at any point of the day, measuring five feet by 10 feet in size as per the Covid-19 protocol. There were at least four burials as per the protocol on May 13 and 14, he added.
Saiyed said, “In the last one week, there have been at least eight burials. I am not aware what the authorities have decided, but whenever a body is brought here from the community, we accord it a respectful burial in line with the protocol. They do not give us any tally.”
A few blocks away at the Bahuchraji Crematorium, where one gas chamber is designated for Covid-19 cremations, more than 45 rituals have been held under the Covid-19 protocol since May 5. One half of a slip handed over to the families at the cremation ground specifies ‘Corona’ to classify the cremation. Of these, at least three deaths occurred since May 14.
On May 15, Vadodara’s Covid-19 tally touched 653 — a jump of 268 cases in ten days. The death toll has gone up from 31 on May 5 to 32 on May 11.
The VMC has confirmed that of the 32 deaths reported so far, seven have been due to Covid-19, 15 due to multiple co-morbidities, six due to hypertension, three due to diabetes and one due to other acute disease — the case of a Nagarwada resident who also had dengue.
On May 7, the civic body had issued a statement and said that details of Covid-19 deaths will be released only as per the guidelines of the state government. It said, “As per the circular issued by the Additional Director of Medical Education and Research, Gandhinagar on April 4, 2020, it is mandatory for a study to be conducted into every death occurring during the Covid-19 pandemic to examine every aspect of the death, for which each Medical College will constitute an audit committee comprising of a community medical expert, clinical expert -medical or pediatric and a critical care expert.”
The medical bulletin, in reference to Vadodara, further stated, “As in case of deaths due to H1N1 (a strain of swine flu), for which death audits are conducted before making it official, deaths due to Covid-19 will also be made official only after a thorough audit by the expert committees at SSG hospital and GMERS Gotri in Vadodara, in consultation with the state government.”
Indian Council of Medical Research (ICMR) guidelines state, “The body, secured in a body bag, exterior of which is decontaminated poses no additional risk to the staff transporting the dead body. The personnel handling the body may follow standard precautions (surgical mask, gloves). The vehicle, after the transfer of the body to cremation/ burial staff, will be decontaminated with 1% Sodium Hypochlorite. At the crematorium/ Burial Ground, staff will practice standard precautions of hand hygiene, use of masks and gloves. Viewing of the dead body by unzipping the face end of the body bag (by the staff using standard precautions) may be allowed, for the relatives to see the body for one last time. Religious rituals such as reading from religious scripts, sprinkling holy water and any other last rites that does not require touching of the body can be allowed. Bathing, kissing, hugging, etc. of the dead body should not be allowed. The ash does not pose any risk and can be collected to perform the last rites.”
Medical Officer of Health, VMC, Dr Devesh Patel said, “It takes about seven to eight days for each death to be audited. During this time, even the suspected cases, who may have died while their reports were awaited, will also be buried or cremated as per the protocol.” He added that the committee is selected by the Dean of the GMERS colleges.
“The daily medical noting of the deceased patient, while he or she was under treatment, is examined in detail. They need to ascertain if the death was a plain Covid-19 death or due to pre-existing co-morbidities,” he said.
An expert attached to SSG hospital told this newspaper that the Covid-19 death audit also includes a visit to the deceased’s house, besides scrutiny of the medical records of the hospitals where the patient was under treatment.
“Patients with pre-existing lung disorders, history of respiratory infections or pneumonia, heart diseases, liver disease, kidney ailments, hypertension, diabetes, blood disorders, neurological disorders, cancer and others, are more susceptible to complications during the Covid-19 treatment, which would have been a successful recovery in absence of the co-morbidity. As the number of cases rise and so does the mortality, it is important to streamline the data by studying the actual reasons of death, so that the exact figures of plain Covid-19 deaths can be made available,” the expert said.
The process is time consuming because the entire sequence of events for at least three weeks preceding the deceased’s Covid-19 diagnosis needs to be mapped, as per new guidelines of the ICMR issued earlier this week.
These guidelines state, “Pre-existing comorbid conditions… increase the risk of developing respiratory infections, and may lead to complications… in a Covid-19 positive individual. These conditions are not considered as (underlying cause of death) as they have directly not caused death due to Covid-19.”